Out-of-hospital cardiac arrests fell under the Affordable Care Act

From Reuters:

In Oregon, the rate of cardiac arrests happening outside of hospitals fell significantly after implementation of the Affordable Care Act and its expansion of health insurance coverage, researchers report.

“The degree of benefit was most surprising: a 17 percent reduction in risk of cardiac arrest (a life-threatening condition where the heart stops pumping) among the middle-aged population for whom health insurance was expanded,” lead author Dr. Eric C. Stecker from Oregon Health and Science University (OHSU) in Portland said by email.

Cardiac Testing After Emergency Department Evaluation for Chest Pain. Time for a Paradigm Shift?

From JAMA:

Cardiovascular disease is the leading worldwide cause of mortality and morbidity. The evaluation of chest pain for suspected acute coronary syndrome (ACS) typically occurs in an emergency department (ED). Chest pain is the second most common reason for an ED visit and accounts for 7 million annual encounters in the United States. Identifying the minority of patients who have ACS is challenging with high stakes, as timely treatment can prevent future cardiac events.1 Missed ACS is also the top reason for malpractice claims against emergency physicians. Consequently, most emergency physicians are unwilling to accept an ACS “miss” rate of less than 1%.2 Thus, the current ED approach to suspected ACS is to err on the side of more testing and more admissions, and results in more than $3 billion in annual hospital costs.3

Deep cuts to Medicaid put rural hospitals in the crosshairs

From CNN (hat tip: Dr. Menadue):

For the hundreds of rural U.S. hospitals struggling to stay in business, health policy decisions made in Washington, D.C., this summer could make survival a lot tougher.

Since 2010, at least 79 rural hospitals have closed across the country, and nearly 700 more are at risk of closing. These hospitals serve a largely older, poorer and sicker population than most hospitals, making them particularly vulnerable to changes made to Medicaid funding.

“A lot of hospitals like [ours] could get hurt,” says Kerry Noble, CEO of Pemiscot Memorial Health Systems, which runs the public hospital in Pemiscot County, one of the poorest in Missouri.

Talks over boosting Illinois Medicaid payments fail

From Reuters:

A U.S. judge should order Illinois to pay Medicaid providers about $1 billion a month to ensure medical care continues for the three million recipients of the health program after talks with the state reached an impasse, according to a court filing on Monday.

The move would cause a huge problem for the cash-strapped state, which has accumulated a $15 billion bill backlog due to a budget stalemate between its Republican governor and Democrats who control the legislature. It could force Illinois to stop making full payments on other state-mandated or court-ordered spending such as pensions and payroll.

The filing in U.S. District Court by attorneys representing Medicaid recipients asked Judge Joan Lefkow to order the state to pay $500 million a month for four months to start reducing a $3.1 billion pile of unpaid bills owed to managed care organizations that turn pay doctors and others

Nation’s Emergency Physicians: Senate’s Alternative to Affordable Care Act Is a Huge Disappointment

Press Release:

The American College of Emergency Physicians (ACEP) today issued a statement deeply critical of the draft health care legislation introduced yesterday in the Senate, known as the Better Care Reconciliation Act, or BCRA. ACEP’s president, Dr. Rebecca Parker, said:

“Senators should vote ‘no’ on BCRA as it stands today. After holding out hope that the Senate would develop a bill more in line with our priorities, we are extremely disappointed that the Senate’s health care legislation is no better and actually worse than what was introduced in the House of Representatives, the American Health Care Act. The draft that was introduced yesterday makes sweeping changes to the health care system that directly contradict ACEP’s principles and endanger patient safety and patients’ lives. It is a step backwards from improving the health of the nation.

“Of immediate concern is the gutting of Medicaid coverage for millions of Americans who will likely be uninsured or underinsured as a result. The inevitable consequence of people losing their insurance is increases in patient loads and crowding at emergency departments, which are already seeing record numbers of patients. Similarly, when patients have insurance with astronomical deductibles, they delay regular care until a problem becomes so acute they end up in the emergency department. This new legislation will create burdens on ERs that are unsustainable and dangerous.

“In addition, the loss of guaranteed coverage for emergency care – which was one of the essential health benefits of the Affordable Care Act – is basically a gift to insurers, who historically have always chosen to deny coverage when given the option. Access to emergency medical care is critical to all Americans, as is insurance coverage for that care. In a recent poll, Americans overwhelmingly — 95 percent— wanted health insurance companies to cover emergency medical carei.

“We also have grave concerns that this bill does nothing to address the epidemic of opioid and drug dependence in the country, which led to a 99 percent increase in emergency department visits between 2005 and 2014.ii No members of the medical profession see the scourge of opioid addiction more than emergency physicians. The amount of money set aside by BCRA for treatment of the disease of addiction is no better than pocket change.

“Next week, Senators have an opportunity to offer amendments to address the numerous problems that currently exist in BCRA. We hope they are given ample opportunity to discuss and amend the gaping holes in this legislation. Our concerns, which are shared by virtually every other medical group, should serve as a wake-up call to all members of Congress. Without significant improvements, ACEP cannot support this bill and urges members to vote ‘no’ on BCRA.”

i http://newsroom.acep.org/2017-03-16-Public-Overwhelmingly-Wants-Insurance-Companies-To-Cover-Emergency-Care-and-To-Be-Transparent
ii https://www.hcup-us.ahrq.gov/reports/statbriefs/sb224-Patient-Characteristics-Opioid-Hospital-Stays-ED-Visits-by-State.pdf

People with mood disorders receive 51% of opioid prescriptions

From Axios:

The number of opioids prescribed quadrupled from 2011 and 2013, and 19% of Americans with mood disorders have used opioids — compared to 5% of the total population, according to a new study in the Journal of the American Board of Family Medicine. 51% of all opioid prescriptions in the U.S. are given to people with anxiety, depression or other similar disorders.

Rural hospitals could see biggest cuts in AHCA

From Newschannel20:

Under the Affordable Care Act, the uninsured rate has been cut in half but for some, skyrocketing premiums are putting a strain on Americans.

“Our hospitals, that’s a cost they’re absorbing right now too,” Dave Gross with Illinois Health and Hospital Association said. “So, the exchanges do need fixed.”

Many rural hospital representatives we spoke with say the proposed replacement, the American Health Care Act, doesn’t do much for rural Illinois. It ends the ACA’s federal match for Medicaid coverage, leaving it up to states to make up for the loss.

“Given the state of Illinois’ budget problems, it’s something we’re not very optimistic about, being able to make up that difference,” said Aaron Puchbauer, the CEO at HSHS Good Shepard Hospital in Shelbyville.